Provider Demographics
NPI:1649950676
Name:ADE-OSHIFOGUN, JOCHEBED (PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:JOCHEBED
Middle Name:
Last Name:ADE-OSHIFOGUN
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3943 AGUA CALIENTE DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-8017
Mailing Address - Country:US
Mailing Address - Phone:708-769-4259
Mailing Address - Fax:
Practice Address - Street 1:3943 AGUA CALIENTE DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88012-8017
Practice Address - Country:US
Practice Address - Phone:708-769-4259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026351363LP0808X
NM70680363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health